Thrombolysis versus primary percutaneous coronary intervention for ST elevation myocardial infarctions at Chilliwack
1Department of Medicine, University of British Columbia, Vancouver, Canada. surinderjanda@shaw.ca
Insights
Chilliwack General Hospital (CGH) patients with ST-elevation myocardial infarctions (STEMIs) experienced significantly longer door-to-balloon times for percutaneous coronary intervention (PCI) than recommended. Thrombolysis was faster but PCI access was limited, indicating a need for improved STEMI treatment protocols at CGH.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Primary percutaneous coronary intervention (PCI) is associated with better outcomes for ST-elevation myocardial infarctions (STEMIs) when administered promptly by experienced operators.
- Timely transfer to a PCI-capable center within 90 minutes is crucial for patients without local access, outperforming thrombolysis.
- Chilliwack General Hospital (CGH) faces challenges due to its location, with travel times to the nearest PCI center ranging from 60 to 120 minutes.
Purpose of the Study:
- To compare the utilization and accessibility of thrombolysis versus primary PCI for STEMI patients at CGH.
- To evaluate the adherence to established treatment time guidelines for STEMI care at a regional hospital.
Main Methods:
- A retrospective chart review of STEMI patients presenting to CGH between January 1, 2004, and December 31, 2005.
- Inclusion criteria were applied to 40 of 67 identified STEMI cases.
- Treatment modalities (thrombolysis or PCI) and associated door-to-treatment times were analyzed.
Main Results:
- The average door-to-thrombolysis time was 46 minutes, with 47% of patients receiving it within 30 minutes.
- The average door-to-balloon time for PCI was 186 minutes.
- No patients receiving PCI at CGH achieved the guideline-recommended door-to-balloon time of under 90 minutes.
Conclusions:
- CGH did not meet the American Heart Association's guideline for a door-to-balloon time of less than 90 minutes for STEMI patients.
- The findings highlight significant delays in PCI access and treatment at CGH.
- Improvements in STEMI protocols and potentially inter-facility transfer logistics are needed to optimize patient care.
Background:
Studies have shown that primary percutaneous coronary intervention (PCI), when performed by an experienced operator immediately after admission in a high-volume tertiary care centre, results in lower in-hospital mortality, and decreased risk of reinfarction and stroke. Furthermore, for those communities without a PCI centre, transport of patients to a PCI centre within 90 min is superior to thrombolysis. Chilliwack General Hospital (CGH, Chilliwack, British Columbia) has a unique situation - the travel time to the nearest coronary catheterization centre (Royal Columbian Hospital, New Westminster, British Columbia) is between 60 min and 120 min.
Objectives:
To compare access to and use of thrombolysis versus PCI in individuals with ST elevation myocardial infarctions (STEMIs) at CGH.
Methods:
A retrospective chart review was conducted on patients who presented to the emergency department at CGH with STEMIs between January 1, 2004, and December 31, 2005. Of the 67 patients who had a STEMI during this time period, 40 patients met inclusion criteria, of whom, 32 received thrombolytics and eight received PCI.
Results:
The average door-to-thrombolysis time was 46 min (95% CI 32 min to 60 min). A door-to-thrombolysis time of less then 30 min was achieved in 15 of 32 patients (47%). The average door-to-balloon time was 186 min (95% CI 166 min to 206 min). A door-to-balloon time of less than 90 min was not achieved in any of the eight patients who received PCI.
Conclusions:
CGH did not meet the American Heart Association guidelines for a door-to-balloon time of less than 90 min.
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